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Friday, 20 November, 1998, 01:03 GMT
Doctors defuse heart timebomb
Surgery is needed to fix a large aneurysm
Doctors have found the safest way to handle aortic aneurysms - a symptomless defect that can cause sudden death.

The finding will give doctors clear guidance on when to intervene without putting patients unnecessarily at risk.

An aortic aneurysm is an area of bulging tissue in the aorta, the main blood vessel leading away from the heart.

The normal size of the aorta is 2cm in diameter. Most doctors agree that immediate surgery is required for aneurysms above 5.5cm.

But confusion has existed over when to act on smaller aneurysms.

Aortic aneurysms have been compared to a timebomb, because they are usually harmless and symptomless while small, but can expand and burst.

Nearly all ruptured aortic aneurysms are fatal without emergency help and immediate treatment.

steth
Monitoring small to medium aneurysms is recommended
Doctors can detect these aneurysms while they are still small, but the operation to fix them involves heart bypass surgery.

This surgery in itself carries a risk to the patient.

Doctors have been unsure in the past as to when is the best time to operate.

But research published in The Lancet medical journal on Friday provides clear guidance to doctors unsure of whether to opt for a risky operation or to monitor the condition until it becomes life-threatening.

Trial

Professor Roger Greenhalgh, professor of surgery at Imperial College School of Medicine in London, was the principal investigator in the study, the UK Small Aneurysm Trial.

It lasted five years and followed the progress of 1,090 patients over the age of 60 with aortic aneurysms.

The British Heart Foundation part funded the trial
Their aneurysms measured from 4 to 5.5cm.

Some 563 of the patients were given surgery and 527 were monitored using ultrasound scans every three or six months.

The study found that it was better to monitor the condition and operate when the aneurysm was 5.5cm in diameter or larger than to operate as soon as it was diagnosed.

The risk of rupture for those who did not have early surgery was 1% while the risk of dying within 30 days of an operation for those who did was 5.8%.

The trial also found that it was cheaper to monitor rather than operate straight away.

The authors concluded that their findings showed that early surgery should not be recommended.

Difficult decisions

Professor Greenhalgh said: "Until now doctors have had very difficult decisions to make in caring for people with these 'medium-sized' aneurysms."

"This surgical trial in the UK with a clear result can be seen to produce clear evidence of justification for surgical intervention.

Professor Greenhalgh said the study would reassure patients who were diagnosed with aortic aneurysms because they would know research supported the doctor's chosen course of treatment.

The study was funded by the British Heart Foundation and the Medical Research Council.

Foundation Medical Director, Professor Brian Pentecost, said: "It's easy to forget that not everything in medicine is black and white and sometimes doctors have very difficult decisions to make without clear evidence to help them.

"We're very pleased to have been able to support this study which shows that careful monitoring is just as effective as surgery when it comes to saving lives."

See also:

27 Oct 98 | The Bristol heart babies
27 Oct 98 | Health
11 Nov 98 | Health
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